Worse care is on its way

The Department of Health says that "within three years all NHS Trusts will become Foundation Trusts". As any NHS trust will tell you, a three year timetable is extremely ambitious, if not impossible. To be authorised as a Foundation Trust a trust has to prove that it has the financial stability to be able to handle its budget independently of the government.

The problem is that this is not as simple as it may seem. Hospital trusts have budgets in the hundreds of millions. Unlike the existing 129 Foundation Trusts, who were authorised at a time when there was adequate money in the NHS, the remaining 120 or  so trusts will be subject to rather savage funding cuts. The scandal at Mid Staffs occurred because (at a time of adequate NHS funding) they had to make efficiencies to meet the FT finance governance tests, and they allowed care quality to slip. In response to this, the authorisation tests were tightened to include quality measures too.

In times of adequate funding, the FT authorisation tests were tough, at a time of savage cuts in the NHS they are likely to be impossible. The government says that there is no option: NHS (acute hospital) Trusts will not exist in 2013. There seems to be only one way to square this circle: relax the criteria. Clearly, since there will be a shortage of money, it will be impossible to relax the financial governance criteria. So the only possible solution is that the care quality criteria will be relaxed. Basically, if your local hospital is an NHS Trust (ie, not a Foundation Trust) it will mean that in the next three years the deminishing numbers of managers will be desperately making cuts to try and keep to the squeezed budget and your care will suffer. There will be fewer clinical staff and waiting lists will lengthen.

After Mid Staffs we all hoped that such conditions would never happen again, instead the likelihood is that it will happen to at least one hospital in the next three years, and probably with worse consequences. The frightening thing is that it could be your local NHS hospital.

Incidentally, if your local hospital is already a Foundation Trust then they too are unlikely to continue to give high quality care. The reason is that they will be subject to the same straitened financial conditions and to balance their books they will have to compromise the quality of care. But, you ask, surely this will mean that they would be in breach of their FT authorisation? Indeed, and before Lansley got his greasy paws on the NHS such hospitals would be put on the equivalent of the NHS "naughty step" by being de-authorised as a FT and have the privileges of autonomy of their finances taken away. However, Lansley has said that he will legislate to remove the ability of de-authorising trusts. This means that once a trust is a Foundation Trust whatever it does it will always be a Foundation Trust.

It used to be the case that authorisation as a Foundation Trust was an accolade but now it appears to be precisely the opposite.